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CoUege  of  ^fjpgtcians;  anb  ^urgeon^ 
ILihvavy 


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EXPERIMENTAL  INQUIRY 


INTO    THE 


PROXIMATE  CAUSE  OF  BEAT 

FROM 

SUSPENDED  RESPIRATION 


IN 


DROWNING  AND  HANGING, 

WITH  THE  MEANS 

OP 

RESUSCITATION. 

Submitted  as  an  inaugural  essay  to  the  public  examina- 
tion OF  THfi;  trustees  and  professors  op  the  Collegf. 
OP  Physicians  and  Surgeons  in  the  university  of 

THE    state    op   NeW-YORK, 

SABIUEL  BARD,  M,  D.  President, 

FOR   THE 

DEGREE  OF  DOCTOR  OF  MEDICINE, 
On  the  3d  of  May,  1814. 


BY  ANSEL  W.  IVES, 
Honorary  Member  of  the  American  Msculapian  Societi/, 


NEW-YORK  :  PRINTED  FOR  THE  AUTHOR, 


7. 


M 


,*^ 


TO 

VALENTINE  MOTT,  M.  D. 

Professor  of  the  Principles  and  Practice  of  Surgery  in  the  Univer- 
sity of  the  State  of  New-York,  Corresponding  Member  of  the 
Medical  Society  of  London^  SfC.  SfC. 

This  humble  Essay- is  respectfully  inscribed  as  the  only  tribute 
in  the  Author's  power  to  offer,  for  private  friendship,  and  profes- 
sional instructions,  which  no  tribute,  however  ample,  could  com- 
pensate. Y 

That  the  success  of  DOCTOR  MOTT,  in  his  professional  pur- 
suits may  be  equal  to  his  inerit,  and  that  the  first  disposition  of 
bis  heart — the  desire  of  doing  good  to  his  fellow-men,  may  be 
fully  gratified,  will  ever  be  the  first  wish  of  his 

Sincere  friend,  and 

grateful  Pupil. 

ANSEL  W,  IVES. 


N  • 


TO 

DOCTOR  BARTOW  WHITE, 

Pkesident  op  the  Dutchess  Medical  Society,  New-Yor^j 
DOCTOR  ELISHA  NORTH, 

New  London,  (conn.) 

AND 

DOCTOR  ERASTUS  L.  HART, 

Goshen,  (Conn»)        5 
THIS  DISSERTATION 

IS   MOBT   RESPECTFULLY   DEDICATED    BY    THEIB- 
GRATEFUL   FRIEND  AND   PUPIL, 

THE  AUTHOR, 


AN 


EXPERIMENTAL  INGIUIRY,  &c. 


The  investigation  of  the  proximate  cause  of  death  in  Sus- 
pended Respiration  from  Drowning  and  Hanging,  is  difficult  and 
ibstruse,  as  it  immediately  involves  the  consideration  of  the  es- 
sential principles  of  life.     Not  to  dwell  on  the  incomprehensible 
connection  between  mind  and  matter  ;  and  the  mysterious  law 
ly  which  one  operates  upon,  and  vivifies  the  other  ;   not  to  deal 
1  speculations  too  deep  and  refined  for  the  human  intellect  to 
^rasp,  let  us  for  a  moment,  advert  to  the  complexity  of  the 
human  machine,  considered  as  matter  alone.   We  see  a  machine 
operated  on  by  a  power  which  we  cannot  define   cannot  exam- 
ine cannot  comprehend.     Let  us,  therefore,  dismiss  this  invisi- 
ble agent,  and  confine  ourselves  solely  to  that  machine.     Every 
part  of  this  curious  piece  of  mechanism  is  essential  to  the  per- 
fect operation  and  unabated  energy  of  the  whole  :  one  part  in 
a  greater,  another  part  in  a  lesser  degree.     But  our  greatest  in- 
quiry is,  what  parts  are,  and  what  parts  are  not  essential  to  its 
operating  at  all. 

By  determining  on  these,  we  shall  find  those  principles  on  which 
fe  most  immediately,  and  in  the  strictest  sense  essentially  depends  ; 
id  of  course  the  cause  of  those  disorders  which  instantly  stop 
'^  vital  action  of  the  Hnmo-  r..y;.-.    This  subiecti*j^r''^>- 


(     8     ) 

important,  than  curious  and  interesting.  In  those  disordeia  of 
our  slender  machine  which  produce  their  effect  slowly,  there  is 
time  for  the  Physician,  who  may  be  called  the  human  mechan- 
ist, to  study  their  cause,  and  to  vary  his  expedients  ;  but  where 
the  vital  functions  are  instantaneously  suspended,  the  effort  must 
he  immediate.  Stop  to  consider,  and  the  patient  is  irrevocably 
lost. 

Those  vital  functions  upon  which  life  so  immediately  depends^ 
were  formerly  supposed  to  be  the  Brain,  the  Heart,  and  the 
Lungs.  The  Brain  was  considered  as  the  only  source  of  nervous 
power ;  that  is,  the  only  source  of  motion,  and  sensation.  But 
many  phenomena  were  found  inconsistent  with  this  Theory,  as 
for  example,  the  life  which  remained  in  decapitated  animals, 
and  in  the  heart  when  detached  from  the  body.  To  obviate  this 
difficulty  a  fourth  power  was  added  by  Haller,  denominated  vis 
insita,  a  mysterious  principle  which  no  one  pretended  to  under- 
stand, and  which  might  therefore  be  made  a  safe  head  of  refer- 
ence for  every  incomprehensible  phenomenon.  Thus  the  expla- 
nations of  philosophy  are  often  more  unintelligible  than  the  facts 
she  attempts  to  explain,  and  when  she  cannot  enlighten,  she 
shrouds  her  subject  in  deeper  mysteiy. 

In  the  course  of  this  essay,  I  shall  attempt  to  show,  that  there  is 
a  fourth  vital  organ  which  has  been  but  recently  understood ;  the 
functions  of  which,  \\dll  explain  all  the  phenomena  formerly  at- 
tributed to  the  vis  insiia  ;  and  therefore  as  there  is  no  longer  any 
need  of  this  mysterious  principle,  the  offspring  of  Hypothesis,  it 
is,  or  ought  to  be  exploded.  But  before  I  attempt  this,  it  will  be 
necessary  briefly  to  state  the  Hallerian  doctrine. 

Taking  it  for  granted  that  the  Brain  was  the  only  source  of 
nervous  power,  Haller  supposed  that  the  nerves  and  the  Spinal 
Marrow  which  he  considered  as  a  larger  nerve,  were  the  agents 


(  9  ) 
by  which  the  brain  performed  its  office.  He  also  supposed  that 
the  muscles  possessed  a  contractile  pouter,  or  disposition  to  con- 
tract, which  he  called  irritability  or  vis  insita.  All  animal  motion 
was  attributed  by  him  to  this  contractile  power,  acted  upon  by 'a 
stimulus,  the  stimulus  being  dilTerent  according  to  the  muscle  on 
which  it  was  to  act.  Thus  he  supposed  the  muscles  which  are 
submitted  to  the  control  of  the  will,  and  therefore  called  volun- 
tary muscles,  are  stimulated  to  act  by  the  Brain  through  the 
medium  of  the  nerves ;  but  those  muscles  which  contract  inde- 
pendent of  the  will,  do  not  in  any  measure  depend  on  the  nervous 
power,  as  the  Heart  and  Stomach  for  example,  which  are  suppo- 
sed to  be  stimulated  by  their  respective  contents,  without  any  aid 
or  agency  of  the  nerves.  This  Theory  accounts  in  a  beautiful 
manner  for  the  action  of  those  muscles  in  coma  when  the  will 
is  sleeping  on  its  post.  But  however  ingenious  and  convenient 
the  theory,  it  never  fully  satisfied  either  Haller  or  his  Disciples- 
various  modifications  were  introduced  and  even  facts  were  con- 
troverted. Difficidties,  inexplicable,  v/ere  involved  in  the  theory 
itself,  and  removing  one  absurdity,  only  introduced  another.  It 
was  denied  for  instance,  that  the  heart  possessed  any  nerves ;  and 
though  this  removed,  the  Heart  entirely  from  the  influence  of  the 
Brain,  and  gave  M  up  wholly  to  the  vis  insita;  yet  it  introduced 
another  absurdity — .that  the  Heart  could  be  operated  upon  by  the 
passions,  v.dthout  the  intervention  of  nerves. 

As  the  science  of  Anatomy  advanced ;  as  the  distribution  and 
connection  of  the  nerves  were  better  understood ;  and  the  func- 
tions of  the  vital  organs  more  clearly  defined,  difficulties  in  the 
way  of  this  doctrine  multiplied. 

The  medical  profession  are  in  the  highest  degree  indebted  to 

M.  Bichat,  for  the  light  he  has  thrown  on  this  subject.     Though 

in  his  physiological  researches,  he  did  not  hit  upon  the  novel  ideas 

of  Le  Gallois,  his  experiments  actuallv  tended  to  the  same  coil' 

B 


C    10   )  /. 

elusion,  Gontraiy  as  that  concIiiEiou  was,  to  dwn  belief.  To 
attempt  to  overthrow  a  doctrine  so  well  established  and  supported 
by  the  great  body  of  the  profession,  required  more  than  ordinary 
boldness ;  yet  it  found  opponents  in  men  distinguished  for  science 
and  talents.  The  difficulties  which  embarrassed  it,  would,  in 
spite  of  prejudice,  predilection,  and  the  fear  of  ridicule,  force 
themselves  on  the  mind  of  the  original  thinker,  and  compel  him 
to  doubt.  As  an  instance  of  the  dissatisfaction  which  ingenious^ 
and  reflecting  men  felt  with  this  theory,  an^  of  the  advances 
Whith  were  making  to  the  true  hypothesis,  I  insert  the  follow- 
ing extract  from  a  manuscript  lecture  of  Doctor  Hosacki  de&vered 
at  Columbia  College,  in  this  City,  1798: 

After  describing  the  distribution  of  the  nerves,  he  adds,  "  see- 
ing, therefore,  this  universal  distribution  of  the  nerves  through  the 
differenft  parts  of  the  body— -the  means  by  which  the  capacity  of 
performing  their  functions  is  preserved,  and  the  numerous  connec- 
tions which  takes  place  between  the  nerves  of  the  various  and 
distant  parts  of  the  body,  by  means  of  the  great  sympathetic 
Derve,  and  by  plexus,  we  injer  the  presumpHoUf  that  they  serve 
the  great  purpose  of  supplying  the  body,  not  only  with  sensation, 
hut  motion  ;  and  that  the  vis  insita  is  unnecessary  J&i'  this  purposed" 

But  without  multiplying  authorities,  it  will  be  sufficient,  briefly 
to  state,  that  in  1809,  Dr.  LeGallois,  a  distinguished  French  phy^ 
siolygist,  performed  his  experiments  on  the  principles  of  life.  He 
took  a  path  untrodden  by  former  anatomists.  The  discoverie* 
which  he  made,  were  wonderful,  and  such  as  have  caused,  or  will 
cause,  an  entire  revolution  in  the  theory  of  the  vital  functions. 

From  all  his  experiments  he  deduces  the  following  principles : 
That  the  brain  is  the  organ  of  intelligence,  but  not  as  Haller 
ftupposed  of  sensation  and  motion. 


(     H     ) 

That  the  only  part  of  the  brain  which  is  immediately  essential 
io  life,  is  that  portion  of  the  medulla  oblongata,  from  which  the 
par-vagunii  or  eighth  pair  of  nerves  arises,  via :  the  Corporfa 
Olivaria. 

That  if  this  portion  of  the  medulla  oblongata  be  preserved^ 
life  will  not  be  destroyed,  though  the  remainder  of  the  brain  be 
dissected  off. 

That  this  portion  of  the  Brain  is  essential  to  life  in  a  two  fold 
capacity. 

1st.  As  the  origin  of  the  eighth  pair  of  nerves,  which  are  dis- 
tributed to  the  Heart,  the  Stomach  and  the  Lungs,  and  upon  which 
#ie  functions  of  the  Lungs  exclusively  depend ;  and, 

2dly.  As  it  gives  influence  to  the  nerves  which  supply  the  res- 
piratory muscles. 

That  the  Medulla  Spinalis  is  the  source  of  sensation  and  motion, 
independent  of  the  Brain,  and  that  if  artificial  respiration  be  kept 
Wp  in  decapitated  animals,  life  will  be  preserved. 

But  as*the  Brain  is  the  residence  of  the  intellectual  functions, 
the  motions  of  the  body,  in  this  case,  will  be  accidental,  and  not 
under  the  control  of  the  will. 

That  the  life  of  every  portion  of  the  body  depends  upon  the 
lierves  of  a  corresponding  portion  of  the  Spinal  Marrow,  and 
lience  if  the  Spinal  Marrow  be  cut  into  diflferent  sections,  each 
section  will  be  a  distinct  center  of  sensation  and  motion. 

That  the  Heart  receives  its  principles  of  life  and  of  power 
from  the  Medulla  Spinalis,  but  not  like  the  trunk  from  a  limited 
portion  of  itj  but  from  the  yvholo 


(     13     ) 

Hence  if  any  portion  of  the  Spinal  Marrow  be  destroyed,  the 
force  of  the  Heart  will  be  weakened,  but  if  the  whole  be  destroy- 
ed, its  action  will  suddenly  cease. 

That  this  influence  which  the  Medulla  Spinalis  exercises  over 
the  Heart,  is  through  the  medium  of  the  great  sympathetic  nerve. 

That  as  this  nerve  arises  from  every  portion  of  the  Medulla  Spi- 
nalis, and  not  like  the  nerves  supplying  every  other  part  of  the 
body,  from  a  single  point,  it  serves  to  explain  why  the  action  of 
those  organs  to  which  it  is  distributed,  is  uninterrupted  and  invol- 
untary. 

That  the  action  of  the  Heart  is  not  more  dependent  upon  the 
nervous  power  than  the  nervous  power  is  upon  the  blood. 

That  if  a  portion  of  the  aorta  be  included  in  ligatures,  a  para- 
lysis  of  the  corresponding  portion  of  the  body  ensues. 

Finally  he  concludes,  that  the  Brain  and  Spinal  Marrow  are  the 
Bources  of  sensation,  and  motion,  in  short ;  of  every  thing  which 
constitutes  life ;  and  that  life  is  produced,  and  maintained,  by  the 
impression  of  arterial  blood  upon  these  organs. 

Thus  we  see  that  to  support  life,  a  reciprocity  must  be  main- 
tained in  these  functions,  the  destruction  of  which  is  always  the 
proximatef  whatever  may  be  the  remote  cause  of  death. 

We  liave  said  that  the  Brain  and  nerves  were  excited  to  actio© 
by  the  impression  of  arterial  blood.  But  this  blood  in  its  passage 
through  the  arteries  from  the  left  side  of  the  heart  to  the  most 
extreme  parts  of  the  body,  and  in  its  return  through  the  veins  to 
the  right  side  of  the  heart,  acquires  a  superabundance  of  carbon. 
This  has  the  effect  of  changing  it  from  the  florid  colour  observed 
in  the  arteries,  to  the  dark  purple  it  exhibits  in  the  veins.  But 
what  is  more  important,  it  is  by  this  means  rendered  urMfov  the 


■(     13     ) 

purposes  of  nutrition,  and  secretion,  and  its  sfimiilating  effect 
upon  the  Brain  and  nerves  is  destroyed.  But  these  principles 
are  restored  by  Respiration;  for  in  passing  through. the  Lungs, 
carbon  is  emitted  through  their  thin  air  vessicles,  and  uniting  with 
the  oxygen  of  the  inspired  air,  is  evolved  in  the  form  of  carbonic 
acid  gas.  Thus  the  blood  is  constantly  acquiring  properties 
which  would  destroy  its  agency  in  supporting  liie  j  but  by  this 
process  it  is  as  constantly  purLled. 

Such  are  the  physiological  and  chemical  principles  on  which  i 
have  founded  my  opinion,  as  to  the  proxm.ate  cause  of  death  in 
Suspended  Respiration.  T/  :  :  ; /:  of  the  disease  mil  natu- 
rally result  from,  and  be  su^^--.cd  *  y  U^e  cause.  But  before  I 
proceed  to  state  mj  own  opinion;  I  shall  examine  the  most  popu- 
lar Theories  which  have  hecn  advanced  on  Ibis  subject.  Yolumes 
on  volumes  have  been  written,  and  almost  everj^  author  has 
started  a  Theory  of  his  own  :  some  have  enlightened,  others  have 
only  afforded  more  matter  for  doubt-.  Men  of  great  ingenuity  and 
ability,  they  have  erred  like  great  men  and  have  supported  each 
Ms  own  Hypothesis  with  a  strength  of  argument  which  appeared 
matchless  and  unanswerable  till  you  read  his  opponent.  It  has 
been  from  its  own  nature  an  object  of  great  importance  to  ascer- 
tain the  best  mode  of  treatment  in  this  disease,  and  to  this  intrin- 
sic importance,  adventitious  motives  have  been  added.  The 
Humane  Society  of  London  have  offered  rewards  to  the  most 
successful  champion  in  this  arduous  and  honorable  contest. 
The  prize  has  been  won,  only  to  be  contended  for  and  won  again. 
The  reason  of  this  seemingly  interminable  doubt  as  to  the  proxi- 
mate cause  of  the  disease,  subsisted  in  the  imperfect  knowledge 
and  misapprehension  of  those  functions  upon  which  life  immedi- 
ately depends. 

It  was  formerly  the  most  prevalent  opinion  that  death  was  re- 
motely caused  in  Drowning,  hy  the  presence  of  water  in  the  Lungs, 


(    U    ) 

aad  that  the  circulation  of  the  blood  through  the  pulmunary  arte- 
ides  was  by  that  means  interrupted,  which  was  the  immediate  cause 
of  death.  Others  supposed  water  to  get  into  the  stomach,  and  by 
distention  to  produce  apoplexy.  The  practice  founded  upon  this 
opinion  was  to  suspend  the  patient  by'the  heels  and  agitate  him  as 
much  as  possible  with  the  intention  of  exciting  the  action  of  the 
visera,  and  evacuating  the  water.  Though  the  bad  effects  of  this 
practice  were  acknowledged  by  its  advocates ;  yet  they  contended 
that  remedies  in  some  respects  hurtful,  should  be  used  when  the 
advantages  arising  from  them  preponderated.  Not  to  mention 
the  great  number  of  Theories  previously  advanced,  it  will  be 
sufficient  for  our  present  purpose  to  recur  no  further  back  than 
to  the  important  experiments  of  Doctor  Goodwin, 

His  first  object  was  to  ascertain  whether  death  was  caused  by 
water  in  theLungs.  For  this  purpose  he  immersed  cats  and 
dogs  in  coloured  fluids,  and  in  quicksilver.  Eight  Cats  were 
suffocated  in  quicksilver;  in  three  of  which  none  was  found 
in  the  Lungs  after  death  ;  and  in  no  case  was  there  more 
than  half  an  ounce.  As  the  specific  gravity  of  quicksilver 
is  so  much  greater  than  that  of  water,  he  concluded  that  a 
much  greater  quantity  would  force  itself  into  the  Lungs.  But 
even  the  greatest  quantity  of  quicksilver  taken  in,  was  only  equal 
!n  bulk,  to  seventeen  grains  of  water.  But  more  fully  to  ascer- 
tain the  fact,  he  next  injected  two  ounces  of  water  into  the 
trachea  of  a  Cat.  The  only  inconveniencies  were  a  difficulty  of 
breathing,  and  feeble  pulse.  Hence  he  concluded,  that  the  small 
quantity  of  water  which  might  sometimes  be  taken  in,  was  not 
sufficient,  in  any  case,  to  cause  the  death  of  the  animal.*  This 
opinion  of  Doctor  Goodv^dn  has  been  confirmed  by  the  subse- 
quent experiments  of  Messrs.  Kite  and  Coleman.  And  in  a 
number  of  Cats  which  I  have  dissected,  after  drowning,  but  a 

*  Goodwin  on  the  connection  of  life  -with  respiration = 


(     15     ) 

very  small  quantity  of  water  was  found  in  the  lungs.  As  no 
mention  has  been  made  by  the  above  authors  of  the  appearances 
of  the  Limgs,  when  the  animal  had  been  long  in  the  water  after 
motion  had  ceased,  and  as  we  might  be  induced  to  suppose  water 
might  be  admitted  from  the  relaxation  of  the  glottis  which  ensue?, 
I  determined  on  making  the  following : 

EXPERIMENT: 

A  Cat  was  drowned  and  suffered  to  remain  under  water  twenty 
minutes.  After  motion  had  ceased,  no  air  escaped  trom  the 
Lungs,  and  on  examination  they  were  found  to  contain  no  more 
water  than  had  been  obsferved  after  ordinary  drowning.  This 
experiment  was  repeated  with  the  same  result;  from  which  it 
appears  that  water  in  the  Lungs,  in  no  case,  has  any  agency  in 
destroying  life. 

Doctor  Goodwin  having  proved  that  death  was  not  caused  by 
water  in  the  Lungs,  be  eould  only  suppose  it  to  be  from  suspen- 
ded respiration,  but  whether  this  effected  the  system  mechanically 
or  chemically,  was  a  question  unsettled.  He  supposed  it  to  be 
chemically,  that  the  black  blood  in  the  right  side  of  the  Hearty 
was  unfit  to  stimulate  the  left  side  to  action,  and  that  the  change 
the  blood  underwent  in  the  circulation,  was  solely  to  prepare  it 
for  that  purpose ;  that  in  consequence  of  Suspended  Respiration^ 
the  blood  in  the  left  side  became  black,  and  "  that  the  left  auricle 
and  ventricle  first  cease  to  act,  from  the  inaptitude  of  venous 
blood  to  excite  theif  contraction,  and  that  in  Drowning" — this  is 
the  immediate  cause  that  suspends  circulation— -that  by  the  con- 
tact of  black  blood  in  the  left  side  of  the  Heart,  its  motions  became 
weaker  and  wealj:er  till  they  ceased  ;  whereas,  the  right  side 
being  stimulated  by  the  black  blood  to  which  it  had  been  accus- 
tomed, continued  to  contract  with  full  force.  But  the  appearance? 
on  dissection  do  not  correspond  with  ths  Theory  of  Doctor  GootV 


(     16     ) 

will.  If  as  lie  supposed  the  left  side  of  the  Heart  ceased  to  act 
in  consequence  of  the  sedative  effect  of  the  black  blood,  then 
the  left  Bide  of  tlie  Heart  would  be  found  engorged  with  blood, 
instead  of  the  right,  and  the  right  which  according  to  him  retains 
the  power  of  forcible  contraction,  would  be  found  empty ;  for  it 
13  obvious  that  the  blood  must  be  lodged  in  the  part  where  there 
is  the  greatest  obstriicticn  to  its  passage,  and  the  least  power  to 
overcome  ih  - 

Mow  Doctor  C4oodwin  has  acknowledged  that  from  his  o^vii 
ej-perimcnts,  he  !:j"::!icvG3  the  Lungs  are  never  entirely  destitute 
of  air,  but  even  after  tlie  most  complete  expiration  in  Drowning 
or  Hanging,  Ihat  they  contain  a  considerable  quantity.  Though  I 
am  not  induced  from  my  own  experiments  to  believe  the  quantity 
(o  be  Yerj  great,  1  am  fully  satisfied  that  they  are  never  empty. 
Taking  it  for  granted  then,  that  there  is  always  more  or  less  air 
in  the  I.  d  that  tiicre  is  in  the  blood  a  stimulating  quality 

which  i.  ;_  ...L.iaed  by  carbon,  I  shall  upon  this  supposition 
attempt  to  account  for  the  accumulation  of  blood  in  the  right 
side  of  the  Heart.  It  cannot  be  owirjg  to  the  greater  thinness  of 
the  parietes,  for  vre  must  suppose  that  each  side  has  power  pro- 
portional to  the  oft»*e  through  which  it  lias  to  propel  the  blood. 
But  is  it  not  owing  to  the  greater  ini:?iuiity  of  the  blood  in  the 
right  side  of  the  Heart  Ihaii  in  .\  ■_  .  I  am  aware  that  it  may 
foe  said  m  objection  that  the  blood  is  always  more  impure  in  the 
'  right  side  than  in  the  leit,  and  that  there  is  not  a  greater  relative 
difference  of  impurity  when  respiration  is  stopped,  than  when  it 
goes  on  freely.  But  admitting  this,  let  us  recur  to  another  con- 
sideration, which  we  ought  by  no  means  to  disregard. 

We  suppose  that  the  siimuIatlDg  quality  of  the  blood  can  be 
completely  neutralized  with  carbon,  and  this  wii!  take  place  when 
the  satiiri.-icn  :3  cciDj/kro,    And  will  not  tiiis  happen  first  in  the 


(  ^i  ) 

light  Side  of  the  heart  ?  When  Respiration  is  suspended,  blood 
arrives  at  the  left  side,  but  imperfectly  purified,  and  is  it  not  rea^ 
sonable  to  conclude  that  it  may  be  saturated  with  carbon  before 
coming  again  to  the  right,  as  it  passes  through  and  imbibes  carbon 
from  the  whole  system  ?  But  the  blood  which  passes  from  the 
right  side  of  the  Heart  to  the  left,  though  overloaded  with  carbon 
at  the  moment  it  starts,  is  never  completely  saturated,  for  M  so, 
the  contraction  of  the  ventricle  would  not  be  sufficient  to  propel 
it  through  the  Lungs,  and  it  passes  from  the  right  to  the  left  side 
of  the  Heart  without  any  new  accession  of  carbon,  as  its  whole 
course  is  through  the  Lungs,  in  which  it  has  been  shown  that  a 
small  quantity  of  air  remains  We  may  rather  suppose  that  evea 
to  the  last,  it  receives  some  degree  of  purification  in  passing 
through  the  pulmonary  vessels,  and  should  conclude  a  priori  that 
the  blood  in  the  left  side  of  the  Heart,  would  never  be  completely- 
saturated  with  carbon.  With  this  supposition  experiments  per- 
fectly  agree,  for  in  six  cases  which  I  examined  after  death,  the 
blood  in  the  left  auricle  was  more  or  less  fiorid.  Hence  the  rea- 
son why  little  or  no  blood  is  found  in  the  left  ventrical ;  for  there 
the  last  stimulus  is  excited,  and  the  last  efficient  contraction  takes 
place. 

It  may  be  asked  why,  if  this  Theoiy  be  true,  the  right  ventricle 
contracts  longer  than  the  left  ?  The  reason  is  obvious ;  the  right 
ventiicle  is  stimulated  by  warmth  and  distension,  which  would  no 
doubt  excite  a  feeble  contraction  even  if  the  distendhig  fluid  wera 
water.  But  its  contractions  are  without  power,*  and  though  more 
frequent,  are  evidently  less  forcible  than  those  of  the  left  side 
while  they  continue.  And  after  the  left  side  has  stopped  beating, 
if  the  blood  in  the  right  side  could  be  transmitted  to  the  left,  the 
left  ventricle  would  contract,  as  was  proved  by  the  experiments 
of  Blchat.f 

•  Le  Gallois,  Experiments  on  the  principles  of  I'fe. 

t  Physiological  Researches,  p.  182,. 
C 


(  1§  j 

Mr.  Kite  supposes  that  in  consequeuce  of  suspended  respira* 
lion  the  motion  of  the  Lungs  cease,  and  a  collapse  succeeds,  whicl^ 
mechnaically  obstructs  the  passage  of  the  blood  from  the  right 
to  the  left  side  of  the  Heart ;  and  that  death  is  produced  by  an 
effect  of  this  obstruction  either  on  the  Heart,  the  Lungs,  or  the 
Brain.  This  effect,  he  thinks,  is  not  produced  on  the  Heart, 
because  the  right  side,  where  the  greatest  quantity  of  blood  is 
accumulated,  continues  to  beat  longer  than  the  left;  nor  on  the 
Lungs,  because  their  office  is  merely  passive ;  and,  he  therefore 
concludes,  that  it  can  only  be  produced  on  the  Brain,  by  a  €on* 
gestion  of  blootl  upon  this  organ,  causing  apoplexy.* 

The  objections  to  the  opinion,  that  the  biood  is  mechanically 
interrupted  in  its  passage  through  the  Lungs,  will  be  mentioned 
hereafter.  I  shall  at  present  attempt  to  show  that  death  is  not 
caused  by  a  congestion  of  blood  in  the  Brain.  This  is  a 
theory  that  has  not  only  been  supported  by  Mr.  Kite,  but  also  by 
the  celebrated  Doctors  Borehaare,  Cullen,  and  others;  and  ai 
the  present  day,  it  is  believed  by  many  physicians  of  the  first 
eminence,  that  in  Hanging,  the  pressure  of  the  cord  upon  the  super- 
ficial veins  of  the  neck,  prevents  the  return  of  the  blood  fpom  the 
head,  and  produces  a  fatal  apoplexy.  If  apoplexy  is  produced  in 
either  of  the  diseases  under  considieratioa,  if  would'most  probably 
be  in  Hanging,  for  there  is  the  same  collapse  of  the  Lungs  as  in 
Drowning,  and  there  is  also  the  pressure  of  the  cord  on  the  veins 
of  the  neck,  to  prevent  the  return  of  blood  from  the  Brain. 

In  reasoning  from  analogy,  we  cannot  suppose  that  if  apoplexy 
was  produced  in  this  disease,  death  would  ensue  in  the  short 
space  of  five  or  six  minutes  after  the  stoppage  of  the  blood ;  for 
Mr.  Kite  acknowledges,  that  "  extravasation  does  not  take  place 
in  any  part  of  the  Brain;"  and  it  is  well  known,  that  even  in  apc^ 

*  Kite's  Medical  Essays* 


(     i9  J 
plexy,  produced  by  extravasation,  which  is  of  all  others,  the  mofct 
suddenly  fatal— death  rarely  happens  so  soon.     But  the  opinion 
of  Mr.  Kite  is  not  merely  rendered  improbable  hy  analogy  ;  it  is 
incontrdvertably  disproved  by  experiments. 

Mr.  Coleman  secured  both  the  Carotids  of  a  Dog,  and  in  half  an 
hour  after  suspended  him  by  the  neck.  Ke  died  in  four  minutes. 
On  examination,  the  vessels  of  the  Brain  were  found  less  distend- 
ed than  ordinary.*  This  experiment  has  been  so  often  repeated 
with  the  same  result,  that  there  can  be  no  doubt  of  its  correctness. 

EXPERIMENT. 

1  secured  the  jugular  and  thyroidal  veins  of  a  Cat  by  ligatures 
at  the  same  moment ;  no  symptoms  of  apoplexy  were  apparent. 
At  the  end  of  twenty  minutes  the  animal  was  killed,  and  on 
removing  the  cranium,  the  vessels  were  found  much  distended, 
but  there  was  no  extravasation.  This  experiment  was  repeated 
on  another  animal,  and  the  jugular  and  thyroidal  veins  remained 
in  ligatures  forty  five. minutes — the  result  was  the  same^ 

EXPERIMENT. 

The  trachea  of  a  Cat  was  laid  bare,  and  an  opening  made  just 
below  the  Thyroid  cartilage,  a  cord  was  passed  round  the  neck, 
Immediately  above  the  opening,  by  which  it  was  suspended. 
Air  was  inspired  through  the  opening  in  the  trachea,  and  respiration 
went  on  without  apparent  inconvenience.  There  was  no  visible 
change  in  the  colour  of  the  lips,  tongue  or  nose,  and  the  eyes 
appeared  perfectly  natural.  At  the  expiration  of  ten  minutes,  it 
was  taken  down,  the  hole  in  the  trachea  closed,  and  it  breathed  a& 
usual.  It  was  again  suspended  in  the  same  manner,  and  the  opeu- 
fng  closed.     It  immediately  struggled  violently,  the  lips,  nose  and 

*  Coleman  on  Respiration,  page  143, 


(    20    ) 

tongue  gradually  turned  purple,  the  eyes  became  glassy,  and  it 
appeared  to  be  dying.  At  the  expiration  of  one  minute,  air  was 
again  admitted  into  the  trachea,  and  all  symptoms  of  suffocation 
disappeared. 

From  these  experiments  is  it  not  incontrovertably  proved,  that 
apoplexy  is  not  the  cause  of  death  in  Hanging  ?  And  is  it  not 
rendered  fully  evident  by  the  last  experiment,  that  want  of  air  is 
the  only  cause  of  distress  to  a  suspended  animalj  and  ultimately 
of  death  ? 

Mr.  Coleman,  in  his  Treatise  on  this  subject,  has  attempted  to 
prove  that  the  proximate  cause  of  death  is  both  mechanical  and 
chemical ;  that  in  Drowning  and  Hanging,  the  muscles  of  expira- 
tion continue  to  act  till  they  expel  all  the  air  from  the  Lungs, 
which  they  are  capable  of  acting  on ;  that  in  consequence  of  this 
exhausted  state  of  the  Lungs,  their  air  cells  collapse,  which  pro- 
duces a  mechanical  obstruction  to  the  passage  of  the  blood  in 
the  small  branches  of  the  pulmonary  vessels,  and  that  this, 
together  with  the  want  of  latent  heat  in  the  blood,  constitutes  the 
proximate  cause  of  the  disease.- 

That  the  Lungs  are  in  a  collapsed  state  after  Drowning  and 
Hanging  will  readily  be  granted.  But  the  collapse  is  not  perfect. 
It  has  been  proved  by  Doctor  Goodwin,  that  after  the  most  com- 
plete expiration,  they  contain  a  sufficient  quantity  of  air  to  per- 
mit the  passage  of  the  blood ;  and  I  have  before  observed,  that 
from  my  own  experiments  I  was  fully  satisfied  that  they  were 
Bever  empty. 

But  granting  for  the  present,  that  the  air  is  all  exhausted  in  the 
last  efforts  to  respire,  and  the  collapse  of  the  Lungs  complete,  I 
shall  attempt  to  prove,  that  even  in  this  case,  the  blood  would 
Mot  be  mechanically  obstructed.    We  know  that  the  blood  circu- 

*  Coleman  on  Respiration: 


lates  freely  in  organs  which  are  alternately  distended,  and  col- 
lapsed ;  as  in  the  Heart,  Stomach,  and  urinary  bladder — and  that 
in  other  parts  of  the  system,  though  the  vessels  are  contorted 
and  convoluted,  as  in  the  motions  of  the  limbs,  the  mesentery, 
&c. ;  and  though  these  changes  take  place,  while  the  blood  is 
flowing  from  the  part,  they  neither  prevent  nor  impede  it.  Judg- 
ing from  analogy,  therefore,  we  have  no  reason  to  conclude  that 
a  mechanical  obstruction  takes  place  in  the  Lungs,  And  to 
show  that  it  is  not  the  case,  we  have  not  only  analogical  proofs 
but  experiments  to  ascertain  the  truth  directly  in  point.  Bichat, 
to  ascertain  the  truth  of  this  doctrine,  adapted  the  tube  of  a  syr- 
inge to  the  trachea  of  a  dog,  after  cutting  it  transversely,  and  sud* 
denly  emptied  the  Lungs  of  all  their  air,  at  the  same  time  opening 
the  caroted  artery.  In  this  experiment,  the  ciroulation,  he  observe?^ 
should  have  been  suddenly  interrupted,  as  the  pulmonary  vessele 
passed  all  at  once  from  their  ordinary  degree  of  extension,  to  the 
greatest  possible  involution ;  yet  the  blood  continued  for  some  time 
to  be  thrown  out  with  force  by  the  open  artery,  and  consequently, 
to  circulate  through  the  collapsed  Lungs.* 

But  to  ascertain  if  possible,  more  decisively,  whether  the  great. 
quantity  of  blood  found  in  the  right  side  of  the  Heart  vms  owing 
to  a  collapse  of  the  Lungs,  I  had  recourse  to  the  follovang 

EXPERIMENTS : 

The  trachea  of  a  Cat  was  cut  transversely,  and  the  capacity  ol 
the  Lungs  about  half  filled  with  atmospheric  air.  The  ti*achea 
was  then  secured  by  a  hgature.  The  left  ventricle  continued  tt> 
contract  forty  minutes.  The  right  ventricle  continued  to  con= 
tract  twenty  minutes  longer,  when  all  motion  ceased ;  on  ex- 
amination, the  quantity  of  blood,  in  the  right  side,  was  to  thai 
In  the  left,  as  two  to  one. 

*  Physiological  Researches,  p,  174. 


C  22  ) 
jexperiment. 

The  thorax  of  a  Cat  was  opened  and  from  the  pressure  of  the 
dense  atmosphere,  the  Lungs  suddenly  collapsed  and  respiration 
ceased.  The  Heart  and  arteries  contracted  with  great  force,  and 
on  opening  into  the  abdomen,  the  mesenteric  arteries  continued 
to  pulsate  distinctly.  As  their  florid  colour  gradually  changed  to 
purple,  their  motions  became  feeble ;  but  at  the  expiration  of 
twenty  minutes,  the  blood  evidently  circulated  through  the  Lungs. 
On  opening  into  the  Heart,  the  right  ventricle  and  auricles  were 
found  surcharged  with  venous  blood,  the  left  auricle  and  ventricle 
contained  a  small  quantity  of  blood,  but  more  florid  than  that  in 
f^e  right. 

From  the  first  of  these  experiments,  it  appears,  that  death  en- 
sues in  Suspended  Respiration,  when  the  Lungs  are  not  collapsed ; 
and  that  the  blood  is  found  as  in  death  from  other  causes,  prin- 
cipally lodged  in  the  right  side  of  the  Heart.  From  the  second, 
that  the  circulation  continues  sometime  after  the  Lungs  are  col- 
lapsed ;  whereas,  if  it  was  impeded  by  the  collapse,  the  obstruction 
vrould  be  as  complete  at  the  time  of  the  last  expiration,  as  it 
would  at  any  future  period.  This  fact  is  sufficient  to  disprove 
Mr.  Coleman's  opinion,  for  he  does  not  agree  with  ]VIr.  Kite,  that 
the  circulation  is  impeded  by  a  want  of  motion,  but  says,  "  the 
right  side  of  the  Heart  can  propel  blood  to  the  left  immediately 
Sifter  the  last  expiration,  independent  of  the  mechanical  action  of 
the  Lungs,  and  as  it  can  perform  this  function  after  Respiration 
has  ceased,  it  is  probable  that  the  Lungs  have  naturally  no  active 
power  of  propelling  the  blood  onward." 

Te  what  has  been  said  against  Mr.  Coleman's  theory,  so  far  as 
respects  the  collapse  of  the  lungs,  I  shall  only  add  one  of  his  own 
experiments,  by  which  he  attempted  to  disprove  the  opinion  of 

Mr-  E^t^  r 


(     23     ) 

"  EXPERIMENT." 

<«  The  trachea  of  a  Dog  was  laid  bare,  and  secured  by  a  ligatur^^ 
and  this  was  endeavoured  to  be  performed  at  the  instant  an  en- 
spiration  was  made;  in  less  than  four  minutes  he  ceased  t@ 
struggle.  On  examining  the  Heart,  we  found  the  quantity  of 
blood  in  the  left,  when  compared  to  that  of  the  right,  as  thirteen 
to  twelve.  A  portion  of  the  cranium  was  removed,  and  the 
veins  of  the  head  were  evidently  less  distended  than  natural, 
"Here  then,"  says  Mr.  Coleman,  '•'  there  being  no  obstruction  to 
the  passage  of  the  blood  through  the  lungs,  it  could  not  be  col- 
lected  in  the  right  side  of  the  heart,  and  consequently  no  ac- 
cumulation was  found  in  the  head,  and  yet  this  animal  died  as 
soon  as  other  animals  from  ordinary  Hanging,  which  carries 
conviction  to  my  mind,  that  apoplexy  forms  no  part  of  the 
disease,"* 

In  this  experiment  of  Mr.  Coleman's,  I  have  found  it  difficult 
to  account  for  the  death  of  the  animal  by  any  theory  at  that  time, 
extant.  He  proves  that  it  did  not  happen  by  apoplexy,  and  full 
as  conclusively,  that  it  did  not  happen  by  a  collapse  of  the  lung?^ 
and  we  must  conclude,  a  priori,  that  the  senses  of  Mr.  Coleman 
deceived  him,  and  that  the  animal  did  not  die;  otherwise  we 
must  deny  this  poor  Dog  the  common  right  exercised  by  all  ani- 
mals, of  dying  philosophically. 

If  then  a  collapse  of  the  lungs  is  not  the  proximate  cause  of 
death,  I  shall  next  examine  whether  it  is  a  diminution  of  animal 
heat. 

Mr.  Coleman  supposed  the  motion  of  the  Heart  to  depend  upos 
irritability,  which  was  always  in  proportion  to  the  degree  of  animal 
heat ;  that  animal  heat  was  generated  by  Respiration  al©ae ;  conse- 

*  Coleman  on  Respiration,  page  142. 


C    24    ) 

quently  Suspended  Respiration  would  be  a  remote,  and  a  diminu^ 
tion  of  animal  heat,  b.  proximate  cause  of  death. 

I  have  already  shown  that  the  contractions  of  the  Heart  do  not 
depend  exclusively  on  irritability,  and  in  some  late  experiments 
3Ir.  Brodie  has  demonstrated  that  animal  heat  is  neither  generated 
solely  by  Respiration,  nor  is  it  immediately  essential  to  life.  He 
kept  alive  decapitated  Dogs  and  Rabits,  two  hours,  by  artificially 
inflating  the  Lungs,  though  the  heat  in  the  thorax  diminished  in 
the  mean  time  sixteen  degrees.  This  experiment  was  frequently 
repeated,  and  in  every  case  the  heat  diminished  faster  in  animals 
kept  alive  by  artificial  respiration,  than  in  those  of  the  same  age 
and  species  which  were  suffered  to  61e.  Hence  he  concludes 
that  the  generation  of  animal  heat  depends  upon  the  influence  of 
the  Brain,  though  by  supporting  respiration,  life  may  be  preserved. 
These  experiments  were  repeated  by  La  Gallois,  and  though  he 
says  "  the  results  did  not  appear  to  him  as  regular  as  pretended 
hy  Brodie,  the  temperature  was  considerably  reduced."  If,  in 
addition  to  this,  we  reilect  that  experiments  are  recorded  in  the 
philosophical  transaclions,  in  wliich,  by  a  person  being  placed  in 
a  cold  bath,  and  afterwards  exposed  to  a  cold  easterly  wind,  the 
heat  of  the  body  was  diminished  sixteen  degrees,  without  causing 
any  material  injury;  we  cannot  suppose  a  diminution  of  animal 
heat  to  have  any  immediate  effect  in  destroying  life. 

Dr.  Fothergill,  in  his  excellent  treatise  on  Suspended  Respira 
tlon,  from  drowning  and  suffocation,  supposes  the  proximate 
cause  of  death  to  be  "  the  exclusion  of  air  from  the  lungs,  and 
the  extinction  of  irratibility."  The  first  part  of  this  theory  is 
practically,  but  not  critically  correct.  The  exclusion  of  air  from 
the  lungs  is  the  remote  or  exciting  cause  of  the  disease,  but  is  not 
the  proximate  cause,  accoTdino:  to  the  gener?!  J^ccpptation  of  the 
term. 


As  to  thesecond  part  of  Dr.  Fothergill's  theory,  viz :  that  Which 
Tespeets  the  extinction  of  irrijibility,  a  more  particular  examina' 
tion  of  it  is  necessat^.     The  Doctor  insists  upon  it  with  great 
tenacity  and  zeal,  and  introduces  it  for  the  solution  of  a  variety 
of  phenomena.     We  have  already  had  occasion  to  object  to  the 
existence  of  irrij/lDility,  as  independent  of  the  nerves.     That 
there  is  an  irriljfbility  existing  in  the  muscles,  will  not  be  doubted^ 
but  we  consider  this  irritability  as  depending,  in  all  caseSj  on  the 
vis  nerveUj  which,  as  heretofore  explained,  is  sufficient  to  accouzit 
for  all  the  phenomena  of  the  animal  economy.    Why  then  resort  to 
a  hypothetical  agent,  of  whose  existence  there  was  never  any 
other  proof,  than  that  it  was  convenient  as  a  medium  of  explana- 
tion, and  helped  the  physiologist  out  of  difficulties,  from  which 
he  could  not  otherwise  escape  ? 

•  In  prQof,  that  the  motions  of  the  Heart  do  not  depend  upon  the 
aerv-es,  it  has  been  said  by  some,  that  the  heart  had  no  nerves  § 
by  others,  that  it  had  but  few,  and  that  those  were  not  effected  by 
irritation.^    But  other  anatomists,  who  have  been  either  more 
honest,  or  more  perspicacious,  have  affirmed^  that  the  nerves  of 
the  Heart  are  as  numerous,  and  are  distributed  in  th«  same  man» 
ner,  as  in  the  other  muscles.f    If,  on  irritating  the  nerves  of  the 
Heart,  they  do  not  disturb  the  motions  of  that  organ,  it  only 
proves,  that  these  nerves  are  sui  generis,  and  sensible  to  a  peculiar 
stimulus.     In  apoplexy,  says  Dr.  Fothergill,  all  the  functions  de- 
|)ending  on  the  nerves,  are  suspended ;  but  not  the  motions  of  the 
heart;  and  this  he  adduces  as  a  proof,  that  these  motions  do  not 
depend  on  the  nerves.     But  sensation  is  not  destroyed  in  apo-" 
plexy ;  as  the  Braua  is  diseased,^  which  is  the  organ  of  volition, 
that  faculty  is  suspended,  and  of  course  has  no  power  to  direcl 
laie  action  of  the  muscles.     For  if  (he  liuqib  of  an  appopleclic 

*  Fothergill  on  Suspended  Respiratinn,  p.  65.    7  Le  Gallois,  248, 

D 


(    28     ) 

person  be  pinched,  or  pricked,  it  will  be  partially  drawn  up. 
Though  this  motion  be  weak,  the  reason^s  obvious,  for  as  Le 
Gallois  observes,  "  the  Medulla  Spinalis  is  in  a  morbid  state, 
after  the  injury  or  destruction  of  the  Brain,  as  there  is  an 
intimate  connection  between  them." 

Dr.  Fothergill  supposes,  that  the  vis  nervea  would  be  insuffi« 
cient  to  support  the  continued  action  of  the  Heart.  "  It  does 
not,"  says  he,  "  like  other  muscles,  become  weary  by  incessant 
motion ;  neither  does  it  become  less  irritable  to  the  blood  by  the 
daily  repetition  of  the  stimulus,  any  more  than  the  eye  does  to 
light  the  ear  to  sound,  &,c."  But  the  Doctor  seems  to  have  for- 
gotten, that  the  eye  and  the  ear  exercise  their  functions  through 
the  medium  of  nerves ;  and  that  it  is  a  law  of  the  animal  econo= 
my,  that  the  nerves  of  certain  organs  should  be  operated  upon 
by  stimuli,  peculiar  to  themselves,  and  that  the  heart  may  as  we!! 
be  supposed  to  be  an  organ  of  this  description,  and  to  have 
nerves  excited  by  a  pecuHar  stimulus,  as  the  eye  or  the  ear. 
And  the  Doctor  seems  also  to  have  forgotten,  that  the  eye  and 
the  ear  are  excited  by  a  continued  stimulus,  in  nearly  the  same 
manner  as  the  Heart. 

EFFECTS  OF  SUSPENDED  RESPIRATION  FROM 
DROWNING. 

When  an  animal  is  immersed  in  water,  it  immediately  struggles 
#olently,  and  from  its  disposition  to  breathe,  air  is  expelled  from 
the  Lungs,  as  is  evident  from  the  bubbles  rising  through  the 
water.  As  the  distress  for  the  want  of  air,  increases  with  every 
expiration,  efforts  to  inspire  are  repeated,  and  the  expiration 
made  more  complete.  During  these  struggles  which  continue  a 
sniBute^  aiid  m  some  eases,  a  minute  and  a  half,  the  eyes  gradu- 


<     S7     ) 

4iiy  assume  a  glassy  appearance,  and  are  somewhat  protruded^ 
the  pupils  are,  unusually  dilated,  and  the  nose,  lips,  and  tongue,  arc 
In  same  cases  pale,  in  others,  lived.  After  all  external  motion 
has  ceased,  and  the  animal  is  taken  from  the  water,  the  Heart  is 
felt  to  beat  feebly ;  on  pricking,  or  pinching  the  legs,  they  are 
partially  drawn  up,  and  if  amputated,  dark  coloured  blood  issues 
from  the  arteries. 

On  openmg  into  the  Thorax,  the  Lungs  are  found  much 
collapsed ;  a  small  quantity  of  frothy  fluid,  can  generally  b^ 
squeezed  from  them ;  being  evidently,  the  mixture  of  the  air  re-' 
maining  after  the  last  expiration,  with  a  small  quantity  of  watef^ 
which  in  the  attempt  to  inspire  was  taken  in.  The  Veins  appear 
preternaturally  full,  and  of  an  unusually  dark  colour;  the  right 
auricle  and  ventricle,  are  much  more  distended  than  the  left,  and 
are  of  a  darker  colour ;  both  auricles  and  ventricles  now  contract 
miiformly,  but  their  motions  soon  become  weak.  In  about  twenty 
minutes,  the  contractions  in  the  left  ventricle  begin  to  intermit  ; 
the  right  auricle  and  ventricle,  are  comparatively  much  distended, 
and  are  of  a  dark  purple;  their  contractions  continue,  butarefee- 
ble  and  ineffective,  and  much  less  forcible  than  those  of  the  left 
aide  when  they  do  occur.  The  right  ventricle  next  ceases  to  con- 
tract, and  the  last  motion  is  seen  in  the  corresponding  auricle, 
commonly  at  the  expiration  of  an  hour  and  a  half.  If  after  all 
motion  has  ceased,  the  Heart  be  opened,  the  right  ventricle  and 
auricle,  and  all  the  contiguous  veins  are  tilled  with  black  blood, 
the  left  auricle  contams  aboutone  third  as  much  blood  as  the 
Tight,  and  it  is  of  a  more  florid  colour^ 

On  opening  into  the  Brain,  the  superficial  veins  appear  a  little 
more  full  thau  ordinary,  bat  in  no  case  is  there  aoy  ©xtravaeatioB 


r 


BFlPBCTS  OF  SUSPENDED  RESPIRATION  FROM 
HANGING. 


Wlien  an  animal  is  suspended  by  the  neck,  death  is  not  so  im 
mediate  as  in  drowning,  for  as  observed  above,  in  the  one  case 
motion  ceases  in  a  minute,  or  a  minute  and  a  half,  whereas,  in  the 
other,  it  commonly  continues  five  or  six  minutes.  This  is  prob- 
ably owing  to  the  imperfect  stoppage  of  the  trachea  in  Hanging, 
and  the  admission  of  a  small  quantity  of  air  in  the  efforts  to  in- 
spire. Tliis  imperfect  exclusion  of  the  air,  is  no  doubt  the  cause 
of  the  difference  in  the  appearances  in  Drowning  and  Hanging,  du- 
ring and  after  death.  For  in  Hanging,  the  mouth  and  nose  gradually 
assume  a  livid  hue,  and  before  death,  are  of  a  dark  purple  colour^ 
the  eyes  are  more  prominent  than  in  Drowning,  and  the  muscles 
in  some  cases  are  stiff. 

On  opening  into  the  chest,  the  Lungs  are  collapsed  the  same 
%s  in  Drowning,  they  contain  but  a  small  quantity  of  air,  and  the 
Heart,  and  bloodvessels  in  both  cases  exhibit  nearly  the  same  ap- 
pearance. 

The  vein^,;  of  the  Brain   are    a   little    more  turged  than 
4fter  Drowning,  but  as  in  that  case  there  is  no  extravasation. 

After  describing  the  changes  effected  by  Drowning  and  Hang- 
ing, and  the  appearances  of  the  vital  functions  after  death,  we 
xnay  conclude,  that  whatever  is  the  proximate  cause  of  death  in 
the  one,  is  also  the  proximate  cause  of  death  in  the  other ;  that 
the  trifling  difference  in  the  appearances  on  dissection,  is  owing 
principally  to  the  difference,  both  of  the  medium  in  which  the 
animal  is  destroyed,  and  the  time  in  which  it  is  dying. 

In  Drowning  and  Hanging,  the  ingress  of  air  into  the  lungs  is 
Ijiterriaptedj  stud  their  mechaDical  action  arrested.    The  effect 


(    £9  .) 

iipon  the  system  is  immediate;  for  upon  this  mechanical  actioB» 
is  that  chemical  process  founded,  which  is  indispensable  for  the 
purification  of  the  blood.  The  blood  now  returns  to  the  right 
side  of  the  Heart,  and  is  again  propelled  through  the  lungs. 
A  portion  of  the  carbon  is  disengaged  by  uniting  with  the  small 
quantity  of  oxygen  yet  remaining ;  but  the  quantity  is  so  small^ 
that  the  change  is  imperfect.  The  blood  now  begins  to  loose  it& 
influence  upon  the  nervous  system  :  but  where,  and  in  what  de* 
gree,  is  this  effect  produced  ?  Is  it  as  some  have  supposed  upon 
a  particular  organ  ?  We  presume  the  paralysis  to  be  limited  only 
by  the  extent  of  the  nervous  power.  If  it  has  more  effect  upon 
one  side  of  the  Heart  than  the  other,  it  is  only  because  in  that 
aide,  its  impurity  is  greatest.  For  though  every  part  of  the  body 
suddenly  feels  the  effect,  it  is  exclusively  through  the  medium  of 
the  nerves,  and  the  failure  of  excitement  is  always  in  proportion 
to  the  change  of  colour  in  the  blood,  that  is  in  proportion  to  the 
accumulation  of  carbon.  Hence  I  conclmle  the  Proximate  Cause 
of  the  disease,  to  be  an  excess  of  carbon  in  the  blood. 

Whether  this  effect  of  carbon  on  the  nerves,  is  negative  or 
positive,  mediate  or  immediate,  may  be  doubted;  or  in  other 
words,  it  is  doubtful,  whether  carbon  paraUzes  the  nerves  them- 
selves, or  destroys  some  stimulating  quality  in  the  blood,  and 
causes  it  to  fail  in  its  usual  effect  in  exciting  the  nervous  energy. 
But  I  am  inclined  to  the  latter  opinion,  namely  :  that  the  carbon 
neutralizes  some  quality  of  the  blood ;  for  when  Respiration  is 
restored  after  being  suspended,  and  the  carbon  is  thrown  off",  the 
nerves  instantaneously  recover  their  tone  :  whereas,  if  the  influ- 
ence upon  them  had  been  positive,  their  tone  would  not  be  instanta- 
neously, but  gradually  recovered.  But  in  either  case,  where 
does  this  deleterious  principle  first  exert  its  influence?  It  first 
comes  in  contact  with  the  Lungs  and  the  Heart;  the  vis  nerva 
feels  the  want  of  its  accustomed  Btimu!us«-the  power  of  the  heart 


(     30     ) 

begiRB  to  diminish— the  carbonized  blood  enters  the  coronary 
arteries,  and  every  fiber  of  the  Heart  feels  the  effect.  No  sooner 
is  the  blood  propelled  through  the  sj-stem,  than  the  Brain  and 
Spinal  Marrow  begin  to  loose  their  influence  upon  the  Heart. 
No  longer  excited  by  the  arterial  blood,  upon  which  their  energy 
depends,  the  effect  is  now  as  extensive  as  the  nervous  system. 
The  glands  and  absorbents  loose  their  power  of  action,  and  the 
secretions  and  excretions  are  stopped.  The  nerves  of  the  Heart, 
accustomed  to  the  stimulus  of  the  blood,  continue  to  excite  it  to 
contraction,  after  the  energy  of  every  other  part  is  destroyed. 
The  left  ventricle,  which,  for  reasons  before  mentioned,  is  most 
powerfully  stimulated,  forces  the  blood  through  the  arteries,  it 
returns  slowly  in  the  veins,  incapable  of  exerting  a  contraction, 
sufficiently  forcible  in  the  right  side  of  the  Heart  to  propel  it 
through  the  Lungs,  it  accumulates  in  the  veins,  and  right  side  of 
the  Heart ;  and  by  warmth  and  distention,  excites  a  feeble  motion 
in  the  right  auricle  and  ventricle,  till  life  is  totally  extinguished. 

TREATMENT, 

It  would  be  highly  interesting  and  important,  to  ascertain  pre- 
cisely how  long  Respiration  may  be  suspended  without  destroying 
life.  "  The  last  signs  of  life"  says  Doctor  Le  Gallois,  "  are  sen- 
sation and  the  circulation  of  the  blood."  We  have  already  said 
that  Doctor  Le  Gallois,  supposed  life  to  be  produced,  and  main- 
tained by  the  impression  of  arterial  blood  upon  the  Brain  and 
medulla  spinalis,  or  by  a  principle,  resulting  from  this  impression.* 
Life,  therefore,  can  only  be  restored  in  those  cases,  where  the 
Heart  has  sufficient  power  to  propel  the  Mood  to  the  Spinal  Mar- 
row, that  the  Spinal  Marrow  may  be  excited  again  to  give  energy 
to  the  Heart  But  there  is  no  infallible  criterion,  whichVill  ena- 
ble us  to  determine  the  degree  of  nervous  energy  remaining  in 

*  Er:periment3  oi  tbe  Principles  of  Life, 


{■  ■  31     ) 

the  Heart.  Much  wiil  idepend  upon  the  age  and  constitution  ot 
the  person.  Cases  are  related  by  the  Royal  Humane  Society,  of 
recoveries,  thirty,  thirty  five,  and  in  one  case,  forty  five  minutes 
after  submersion.  But  in  others,  after  the  utmost  exertion  the 
patient  died,  though  he  had  been  in  the  water  but  three  minutes. 

Seldom  is  a  person  recovered  after  he  has  been  under  water 
fifteen  minutes.  Either  no  credit  is  to  be  given  to  the  accounts 
of  certain  early  writers,  or  we  must  conclude  the  people  of  their 
time  to  have  been  amphibious.  Kunckel,  says,  "  that  in  Sweden, 
no  one  doubted  the  possibility  of  restoring  the  life  of  a  person 
who  had  been  under  water  eight  days  ;'*  and  Burmann,  relates  a 
case,  where  "  a  person  continued  under  water  seven  weeks, 
notwithstanding,  which,  he  not  only  recovered,  but  enjoye(^ 
health  many  years  after." 

We  may,  however,  form  some  opinion,  aa  to  the  probability  of 
a  recovery,  when  we  can  obtain  no  information  respecting  the 
time  the  body  has  been  in  the  water.  If  pricking  or  pinching  the 
limbs  excites  any  motion ;  if  they  are  flexible,  if  on  placing  a 
thermometer  under  the  tongue,  we  find  that  animal  heat  is  not 
all  extinguished,  there  is  hope  of  recovery.  But  if  the  limbs 
and  body  be  stifif,  the  countenance  cadaverous,  the  eyes  dim  and 
sunken,  and  the  heat  of  the  body  extinguished,  we  have  no  more 
encouragement  to  attempt  Resuscitation,  than  after  a  natural 
death.  But  if  all  the  circumstances  attending  the  submersion  can 
be  ascertained,  it  will  aid  us  much  in  forming  an  opinion  as  to 
the  probable  result  of  the  case.  It  is  important  to  kuovr  whether 
the  person  was  timid,  intoxicated,  or  subject  to  fits,  or  whether 
he  fell  from  a  great  height.  The  temperature  of  the  water  oughl 
also  to  be  taken  into  consideration.  But  we  would  tolerate  no 
inquiries  at  the  expense  of  time.  The  most  important,  nay  th^ 
essential  means  of  recovery,  first  to  be  tised,is  i»  all  cases  the  same. 


r 


(     32     ) 

We  have  been  recommended  to  convey  the  patient  carefuliy  to 
the  most  convenient  place  for  using  the  means  of  recovery ;  but 
if  we  reflect  that  the  force  of  the  Heart  diminishes  with  every 
pulsation,  and  that  if  life  is  restored,  it  can  only  be  done  by  re- 
storing the  circulation,  we  shall  never  be  driven  from  the  spot^ 
except  by  intensity  of  cold,  until  respiration  is  restored. 

I  shall  not  attempt  to  detail  the  numerous  modes  of  treatment 
that  have  been  recommended  and  adopted,  by  various  writers  on 
this  subject.  If  the  cause  which  has  been  assigned  for  the  disease 
foe  correct,  the  treatment  will  be  simple,  viz.  those  means  that  are 
immediately  essential  to  restore  Respiration.  Neither  the  symp- 
toms that  will  exist,  nor  the  treatment  which  will  be  necessary 
after  Respiration  ia  restored,  can  be  anticipated.  The  one  will 
in  all  cases  naturally  result  from  the  other. 

When  a  person  is  taken  from  the  water,  unless  we  know  he  has 
been  immersed  so  long  that  there  are  no  hopes  of  his  recovery, 
we  would  immediately  attempt  to  renew  Respiration,  by  artificial 
means.  This  we  would  do  with  the  first  instrument  that  came  to 
hand,  by  which  air  could  be  conveyed  into  the  Lungs.  A  bellows 
would  be  prefered,  to  any  article  in  common  use.  In  case  we 
could  procure  no  instrument  for  inilating  the  Lungs,  we  would 
make  use  of  Astley  Cooper's  expedient,  and  by  pressing  on  the 
sternum  and  ribs,  compress  them,  when  by  lifting  the  hands,  those 
parts  by  their  elasticity  will  restore  themselves,  the  chest  be  ej.- 
panded,  and  the  air  rush  in. 

We  have  supposed  the  caase  of  the  disease,  to  be  excess  of 
carbon  in  the  blood,  that  while  the  circulation  continued,  a  small 
quantity  was  emitted  to  unite  with  oxygen  gas,  in  the  Lungs,  and 
we  must  conclude,  therefore,  that  the  air  inthe  Lungs,  is  not  only 
absolutely  unfit  for  Respiration,  but  positively  deleterious,  the  oxy- 
gen gas  being  changed  into  the  form  of  carbonic  acid  gas.    This 


(     33     ) 

deleterious  air,  can  only  be  expelled  from  the  Lungs,  by  inflating 
them  with  pure  air,  with  which  it  will  mix,  and  gradually  be 
thrown  out  by  artificial  expiration. 

In  order  to  inflate  the  Lungs,  we  would  place  the  body  in  a 
convenient  posture,  with  the  head  elevated,  and  introduce  the 
pipe  of  a  bellows  into  one  nostril,  while  the  other  nostril  and 
mouth  were  closed  by  an  assistant.  The  inflation  should  be 
gradual— after  which  the  air  should  be  pressed  out  by  the  assis- 
tant, and  this  process  continued.  To  prevent  the  passage  of  the 
air  into  the  stomach,  and  direct  it  into  the  trachea,  the  assistant 
should  press  upon  the  thyroid  cartilage,  and  to  raise  the  epiglottis 
for  the  admission  of  the  air,  the  tongue  may  be  pulled  forward. 
This  process  should  be  commenced  as  soon  as  the  patient  is 
taken  out  of  the  water,  and  no  other  means  should  ever  be  suf= 
fered  to  interpose  a  moments  delay.  Many  things  may  be  done, 
which  are  in  some  degree  advantageous,  but  nothing  can  com- 
pensate for  the  neglect  of  inflating  the  Lungs.  Thus  the  wet 
clothes  should  be  stripped  ofl*,  and  the  body  should  be  wiped  dry, 
wrapped  in  flannel^  and  rubbed  with  a  flesh  brushj  or  with  Uiq 
hand. 

Electricity  will  be  found  very  beneficial  in  stimulating  the 
action  of  the  Heart.  It  should  be  communicated  through  the 
region  of  that  organ  in  slight  shocks ;  and  in  order  to  aid  the 
purification  of  the  blood,  the  excitement  should  be  given  while 
the  Lungs  are  inflated.  Care  should  be  taken  that  the  shocks  be 
not  too  violent.  It  is  well  known  from  experience,  that  a  very 
powerful  shock  paralizes,  instead  of  stimulating  the  energy  of  the 
heart. 

When  the  body  has  been  taken  from  under  the  ice,  and  gene- 
rally whenever  we  have  reason  to  believe  that  it  is  very  much 
chilled,  we  should  be  cautious  in  the  application  of  warmth.    We 

E 


s^ 


♦^  ,  :,  ia  such  cases,  endearour  to  place  the  patient  in  a  tempeia= 
a  few  degrees  higher,  than  that  from  which  he  had  been 
.en,  and  increase  it  as  warmth  returned  to  the  body.  The 
)^mperature  of  the  body  may  be  best  regulated  by  a  bath, 
in  which  the  patient  onght  always  to  be  placed  when  it  can 
be  procured.  We  suppose  that  artificial  Respiration  has  been 
kept  up,  and  been  made  to  resemble  natural  Respiration  as  much 
as  possible,  both  in  manner  and  degree,  that  the  body  of  the  pa- 
tient has  been  wiped  d.-j — that  he  has  been  placed  in  a  proper  tem= 
perature,  and  that  his  skin  has  been  gently  rubbed  with  the  hand, 
or  with  a  flesh  brush.  These  are  the  means  on  which  we  rely 
for  Resuscitation;  and  if  these  fail,  after  a  faithful  trial  of  about 
three  hours,  the  case  is  hopeless.  But  persons  are  frequently 
taken  from  the  water  in  a  lifeless  state,  who  have  been  other- 
wise seriously  injiirged,  than  by  drowniDg ;  as  by  a  fall  from  a 
great  height,  by  intense  cold,  &.c.  and  when  we  have  reason  to 
conclude,  that  such  has  been  the  case,  we  shall  of  course,  vary 
pur  treatment. 

As  to  bleeding,  emetics,  enemas,  kc.  it  is  sufficient  to  say  geyie- 
rally,  that  we  consider  all  depleting  remedies  as  injurious  in  the 
first  stage  of  cure  that  is,  before  the  full  re-establishment  of  Res- 
piration.  Even  if  bleeding  should  remove  the  black  blood  fron 
the  right  side  of  the  Heart,  which  we  much  doubt,  it  would  no 
restore  its  arterial  quality,  on  which  life  immediately  depends 
We  shall  not  point  out  the  path  to  be  pursued  in  the  second  stage 
of  cure.  The  treatment  will  be  regulated  by  the  symptoms  oi 
the  patient,  and  the  Judgment  of  the  physician.  If  oxygen  could 
be  procured,  it  would  unquestionably  be  a  much  more  probable 
means  of  purifying  the  blood,  and  restoring  the  circulation,  than 
common  ainiospheric  air ;  but  've  cannot  expect,  in  ordinary 
cases,  to  be  able  to  procure  if. 


(     35     I 

TREAT]\IENT  IN  HANGING. 

In  attempting  to  restore  life,  after  Hanging,  the  means  we 
would  practise,  are  much  the  same  as  above  described.  The 
most  important  thing  to  be  done,  is  to  inflate  the  Lungs,  and  to 
establish  artificial  Respiration.  Bleeding  is  very  generally  re- 
commended,  but  as  we  have  reason  to  believe,  from  our  experi 
ments,  as  Vi^ell  as  those  of  others,  that  apoplexy  seldom  takes 
place,  we  would  bleed  only  in  cases  where  there  is  more  than 
ordinary  reason  to  believe,  that  either  apoplexy,  or  a  turgescence 
of  blood  in  the  Brain  has  ensued,  as  v/here  the  patient  has  been 
long  hanging,  or  was  uncommonly  heavy.  In  such  cases,  wc 
would  open  a  jugular  vein.  But  in  the  mean  time,  artificial  Re3= 
piration  should  never  be  intermitted ;  and  we  wish  it  to  be  well 
understood,  that  we  consider  artificial  Respiration  as  the  great 
and  paramount  remedy,  as  well  in  Hanging,  as  in  Drowning,  and 
all  other  remedies,  as  merely  subservient  to  it.  To  stop  artificial 
Respiration,  for  the  purpose  of  practising  any  other  opedientj 
would,  in  our  opinion,  be  as  inexpedient,  as  to  open  a  vein,  or 
apply  a  blister  in  an  ordinary  case,  and  at  the  same  time,  to  suf- 
focate the.  patient,  by  immersing  his  head  in  water. 

Before  I  conclude,  1  cannot  deny  myself  the  pxcasure  of 
expressing  my  sentiments  towards  the  Professors  of  this  Univer- 
sity. The  zeal  which  they  have  shown  for  the  improvement  of 
their  pupils,  and  the  ability  with  which  that  zeal  has  been  second- 
ed, must  have  left  an  impression  upon  the  mind  of  every  student, 
which  time  will  not  obliterate.  It  is  a  subject  on  which  I  feel 
more  than  I  shall  venture  to  express— a  subject  on  which  the 
heart  would  dictate,  without  any  toil  of  the  intellect.  When  I 
contemplate  the  satisfaction  with  which  I  shall,  through  the  whole 
coiu'se  of  my  life,  look  back  on  the  time  I  have  spent  in  this 


f    36     ) 

tJni  <  •  sity,  I  cannot  forbear  to  take  a  parting  glance  at  theadvan- 
lag-'js  I  have  enjoyed,  and  to  return  thus  publicly,  my  thanks  to 
*ne  gentlemen,  whose  instructions  have  contributed  to  my  im- 
provement, and  whose  benevolent  condescensions,  have  triily 
made  the  paths  of  wisdom  "  ways  of  pleasantness." 


FINIS, 


COLUMBIA  UNIVERSITY  LIBRARIES     , 

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expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
provided  by  the  library  rules  or  by  special  arrangement  with 
the  Librarian  in  charge. 

DATE  BORROWED 

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DATE  BORROWED 

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HiiWi''^ 


